Schedule Ld (Form Rmft-5-Us) - Ust And Eif Fuels Other Than Gasoline Products And Special Fuels Sold Tax- And Fee-Free To Other Licensed Receivers In Illinois

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Illinois Department of Revenue
UST and EIF
Page ____ of ____
Schedule LD
Fuels Other Than Gasoline Products and Special Fuels
Sold Tax- and Fee-Free to Other Licensed Receivers in Illinois
Attach to Form RMFT-5-US
Step 1: Complete the following information
______________________________________________
Check the product type you are listing on this page.
Company name
Aviation fuel
______________________________________________
1-k kerosene
Your license number
Reporting period __ __/__ __ __ __
Other (specify: ___________________________)
Month
Year
Step 2: Report your tax- and fee-free sales
1
2
3
4
5
6
7
8
9
Invoice date
Invoice
Name of
Bill of lading or
Origin
Destination
Purchaser’s
Invoiced
number
carrier
manifest number
Name of purchaser
(Illinois cities only)
(Illinois cities only)
license number
gallons
(month, day, year)
1
_ _/_ _/_ _ _ _ _____________________________________________________________________________________________________________________________________
2
_ _/_ _/_ _ _ _ _____________________________________________________________________________________________________________________________________
3
_ _/_ _/_ _ _ _ _____________________________________________________________________________________________________________________________________
4
_ _/_ _/_ _ _ _ _____________________________________________________________________________________________________________________________________
5
_ _/_ _/_ _ _ _ _____________________________________________________________________________________________________________________________________
6
_ _/_ _/_ _ _ _ _____________________________________________________________________________________________________________________________________
7
_ _/_ _/_ _ _ _ _____________________________________________________________________________________________________________________________________
8
_ _/_ _/_ _ _ _ _____________________________________________________________________________________________________________________________________
9
_ _/_ _/_ _ _ _ _____________________________________________________________________________________________________________________________________
10
_ _/_ _/_ _ _ _ _____________________________________________________________________________________________________________________________________
11 Add the invoiced gallons in Column 9, Lines 1 through 10. Write the total amount here.
11
_________________
12 If you are filing only one Schedule LD, write the amount from Line 11 here and on Form RMFT-5-US, Line 8, Column 2.
12
_________________
If you are filing more than one Schedule LD, add Line 11 from each schedule, and write the total on Line 12 of the last page.
Also write this amount on Form RMFT-5-US, Line 8, Column 2.
This form is authorized as outlined by the Motor Fuel Tax Law and the Environmental Impact Fee Law. Disclosure of this information is REQUIRED.
RMFT-15 front (R-02/00)
Failure to provide information could result in a penalty. This form has been approved by the Forms Management Center.
IL-492-2315

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